Provider Demographics
NPI:1508834060
Name:PHILLIPS, ROLAND T (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:T
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:6 CARE LANE
Practice Address - Street 2:ROLAND T PHILLIPS MD
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-7625
Practice Address - Fax:518-587-0273
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150273207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0096274906204Medicaid
NY060014714OtherRR MEDICARE
C59243Medicare UPIN
NY0096274906204Medicaid